Detecçao de Taquiarritmias Atriais em Portadores de Marcapassos Bicamerais

Introduçao: O estudo comparou o diagnóstico de taquiarritmias atriais (TA) em portadores de marcapassos bicamerais detectadas por eletrocardiogramas de 12 derivaçoes (ECG) realizados durantes consultas clínicas e avaliaçoes de marcapasso, com detecçoes de TA dos dispositivos implantados. Casuística e método: em uma amostra de 65 pacientes, foram implantados e avaliados marcapassos bicamerais (DDDR) capazes de detectar e gravar eletrogramas atriais (EGM). As principais indicaçoes para o implante foram a doença do nó sinusal (DNS) e o bloqueio atrioventricular total (BAVT). O seguimento foi realizado por meio de ECG seriados e avaliaçoes de marcapasso realizadas uma semana, um, três, seis, nove e 12 meses após o implante. Resultados: TA foram detectadas por ECG em seis pacientes e pelos EGM em 49. Nove apresentaram sintomas; dois, alteraçoes eletrocardiográficas significativas e cinco, gravaçoes relevantes nos geradores. Os sintomas foram mais presentes em pacientes com TA diagnosticadas pelos EGM e naqueles com história prévia de TA. Discussao: Em portadores de marcapassos bicamerais, as TA geralmente sao diagnosticadas por meio de ECG, Holter ou de manifestaçoes clínicas, porém os dispositivos implantados têm revelado validade, qualidade e confiabilidade para realizar esse diagnóstico. Conclusao: As TA foram mais frequentes em análises dos EGM e pacientes com diagnóstico prévio de arritmias. Nao houve diferença na incidência de TA nas indicaçoes do marcapasso (DNS vs. BAVT). O uso dos eletrogramas dos dispositivos permitiu realizar maior número de diagnósticos, indicando que podem ser úteis no acompanhamento dos pacientes que recebem terapêutica medicamentosa para tais arritmias

Detecçao de Taquiarritmias Atriais em Portadores de Marcapassos Bicamerais

Introduçao: O estudo comparou o diagnóstico de taquiarritmias atriais (TA) em portadores de marcapassos bicamerais detectadas por eletrocardiogramas de 12 derivaçoes (ECG) realizados durantes consultas clínicas e avaliaçoes de marcapasso, com detecçoes de TA dos dispositivos implantados. Casuística e método: em uma amostra de 65 pacientes, foram implantados e avaliados marcapassos bicamerais (DDDR) capazes de detectar e gravar eletrogramas atriais (EGM). As principais indicaçoes para o implante foram a doença do nó sinusal (DNS) e o bloqueio atrioventricular total (BAVT). O seguimento foi realizado por meio de ECG seriados e avaliaçoes de marcapasso realizadas uma semana, um, três, seis, nove e 12 meses após o implante. Resultados: TA foram detectadas por ECG em seis pacientes e pelos EGM em 49. Nove apresentaram sintomas; dois, alteraçoes eletrocardiográficas significativas e cinco, gravaçoes relevantes nos geradores. Os sintomas foram mais presentes em pacientes com TA diagnosticadas pelos EGM e naqueles com história prévia de TA. Discussao: Em portadores de marcapassos bicamerais, as TA geralmente sao diagnosticadas por meio de ECG, Holter ou de manifestaçoes clínicas, porém os dispositivos implantados têm revelado validade, qualidade e confiabilidade para realizar esse diagnóstico. Conclusao: As TA foram mais frequentes em análises dos EGM e pacientes com diagnóstico prévio de arritmias. Nao houve diferença na incidência de TA nas indicaçoes do marcapasso (DNS vs. BAVT). O uso dos eletrogramas dos dispositivos permitiu realizar maior número de diagnósticos, indicando que podem ser úteis no acompanhamento dos pacientes que recebem terapêutica medicamentosa para tais arritmias

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030